Tuesday, May 12, 2009

HIV information gains and Politics

Three weeks ago I was fortunate to attend the annual conference of the Canadian Association of HIV / AIDS Research held in Vancouver B.C. It was an interesting blend of significant plenaries by international and Canadian speakers and presentations on the latest Canadian research on various aspects of HIV/AIDS in Basic and Clinical Sciences, Epidemiology and the Social Sciences. There was significant learning on my part that, when added to the material of the previous post, has also stimulated my thinking about best next steps and action for me in this field.

The first plenary, that I attended, was given by Dr. Elizabeth Pisani, former journalist and epidemiologist, author of the well known book on the global action on HIV / AIDS titled: The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS, 2008. [Sample quote: “The health statistics in your newspapers are boiled up out of cauldrons of uncertainty, of best guesses, of spilled samples, of errors corrected on the fly.”] As a former journalist, Pisani brings a skeptical approach to the business of epidemiology and is quite educational in the process.

She opened my eyes to facts that I know, but had not taken the time to put together logically because the conclusion is too unpalatable. In the western world, HIV is transmitted almost solely among the denizens of highly marginalized groups, the majority of whom just happen also to be poor. They are men who have sex with men [MSM], including gay men. [This is a category created to include those many men who do have sex with men but do not identify as gay such as married men, those playing on the down low and those who do not take part in or identify with the “gay subculture”.] The marginalized groups are MSM, intravenous drugs users, aboriginal people, sex trade workers, prisoners and recent HIV+ immigrants.

These groups are seen as being on the wrong side of acceptable and there is no political payoff for our elected officials to approve funding their needs; in this situation, research for a vaccine and appropriate treatment for HIV disease. So there is very little funding. What there is, is shrinking with inflation over theyears. In Canada, there has been no increase in funding in the past 10 years. New funding that was fought for under the Liberal government, was then ignored when the current government came to power just as the funding was about to be implemented. I imagine the story is the same in many other western countries that have elected more right wing governments over the past 15 years.

The attitude towards immigrants seems to be transferred to their home countries, many of which just happen to be identified as "third world" and thus influences our international lack of generosity.

Pisani asks, how can epidemiologic data more effectively influence public health policy? The implications of epidemiological data are often politically or socially unpopular as noted in the previous paragraph, and the data are often not used in a timely or complete fashion. She urges better work; that epidemiological surveillance needs to measure variables relevant to programs and to combine data from surveillance and programs for integrated analysis and interpretation. We don’t need a ZERO risk approach, we need to reduce risk. “Stop torturing the data” to say what we think funders want to hear and even what they say they want to hear. Use the data honestly and say what the data indicates is actually happening.

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